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M. Setaccioli, U. Introini, M. Gagliardi, A. Ramoni, F. Scotti, R. Brancato; Baseline OCT Findings and Visual Acuity in the Combined Treatment of Retinal Angiomatous Proliferations (RAP) With IVTA and PDT: Two Prognostic Factors . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4289.
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To evaluate the correlation between anatomical and visual outcome in eyes affected by Age Related Macular Degeneration (AMD) and Retinal Angiomatous Proliferation (RAP) treated with intravitreal injection of triamcinolone acetonide (IVTA) and photodynamic therapy (PDT).
17 eyes of 17 patients with RAP related to AMD were recruited in a prospective, consecutive, interventional case series. Each patient underwent IVTA at a dose of 4 mg in 0.1 ml followed after 2 weeks by PDT. Patients were evaluated with OCT, fluorescein angiography, indocyanine green angiography (ICG) and clinical exam (using Snellen charts) before and 3 and 6 months after their combined treatment. At baseline patients were divided into two groups (1 and 2) according to the presence of foveal intraretinal fluid as demonstrated on OCT scan (group 1 with foveal fluid, group 2 without). Main outcome measures were changes in best–corrected visual acuity (BCVA) and central macular thickness evaluated on OCT retinal map. Intraocular pressure (IOP) and leakage on fluorescein angiography were also evaluated.
All 17 patients (13 female, 4 male; mean age 76±6 years) completed month 6 follow–up visit; none of the patients was retreated at month 3. Considering all patients, mean BCVA was 0.23 (±0.19) at baseline and 0.18 (±0.21) at month 6; mean foveal retinal thickness measured on OCT was 411µm (±94) at baseline and 198µm (±34) at month 6. In group 1, mean BCVA was 0.45 (±0.21) at baseline and 0.38 (±0.32) at month 6; the mean foveal retinal thickness was 381µm (±144) at baseline and 230µm (±28) at month 6. In group 2, mean BCVA was 0.16 (±0.13) at baseline and 0.12 (±0.12) at month 6; the mean foveal retinal thickness was 420µm (±79) at baseline and 187µm (±29) at month 6. IOP rose above 23mmhg in 2 patients, well controlled with topical treatment.
Combined treatment seems to be effective in restoration of retinal anatomy in patients affected by RAP. When foveal intraretinal fluid is detectable with the OCT, patients complain a poor visual acuity and seems to be no chances of improvement even after the recovery of the oedema. This fact may be related to an anatomical irreversible damage due to the dissection of the retinal layers caused by the fluid. Further studies are needed to better understand the physiopathology of this disease.
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